Risk Adjustment in Health Insurance Exchanges for Individuals With Mental Illness.
Objective: In 2014, an estimated 15 million individuals who currently do not have health insurance, including many with chronic mental illness, are expected to obtain coverage through state insurance exchanges. The authors examined how two mechanisms in the Affordable Care Act (ACA), namely, risk ad...
| Publicado en: | American Journal of Psychiatry Vol. 169; no. 7; pp. 704 - 710 |
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| Autores principales: | , , , |
| Formato: | Artículo |
| Publicado: |
American Psychiatric Publishing, Inc.
Jul2012
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=77696941&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 77696941 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 0002953X API jtl: American Journal of Psychiatry issn: 0002953X maglogo: N pubinfo: dt: Jul2012 vid: 169 iid: 7 pid: 37323 pub: American Psychiatric Publishing, Inc. artinfo: ui: 77696941 10.1176/appi.ajp.2012.11071044 ppf: 704 ppct: 6 formats: tig: atl: Risk Adjustment in Health Insurance Exchanges for Individuals With Mental Illness. aug: au: Barry, Colleen L. Weiner, Jonathan P. Lemke, Klaus Busch, Susan H. affil: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore School of Public Health, Yale University, New Haven, Conn. su: United States Health insurance Mental illness Medical care Medical care costs Medical care laws Reinsurance sug: subj: Health insurance Mental illness Medical care Medical care costs Medical care laws United States Direct group life, health and medical insurance carriers Direct individual life, health and medical insurance carriers Property reinsurance carriers Life reinsurance carriers Accident and sickness reinsurance carriers Automobile reinsurance carriers General and other reinsurance carriers Liability reinsurance carriers Reinsurance Carriers Reinsurance ab: Objective: In 2014, an estimated 15 million individuals who currently do not have health insurance, including many with chronic mental illness, are expected to obtain coverage through state insurance exchanges. The authors examined how two mechanisms in the Affordable Care Act (ACA), namely, risk adjustment and reinsurance, might perform to ensure the financial solvency of health plans that have a disproportionate share of enrollees with mental health conditions. Risk adjustment is an ACA provision requiring that a federal or state exchange move funds from insurance plans with healthier enrollees to plans with sicker enrollees. Reinsurance is a provision in which all plans in the state contribute to an overall pool of money that is used to reimburse costs to individual market plans for expenditures of any individual enrollee that exceed a high predetermined level. Method: Using 2006-2007 claims data from a sample of private and public health plans, the authors compared expected health plan compensation under diagnosis-based risk adjustment with actual health care expenditures, under different assumptions for chronic mental health and medical conditions. Analyses were conducted with and without the addition of $100,000 reinsurance. Results: Risk adjustment performed well for most plans. For some plans with a high share of enrollees with mental health conditions, underpayment was substantial enough to raise concern. Reinsurance appeared to be helpful in addressing the most serious underpayment problems remaining after risk adjustment. Risk adjustment performed similarly for health plan cohorts that had a disproportionate share of enrollees with chronic mental health and medical conditions. Conclusions: Cost models indicate that the regulatory provisions in the ACA requiring risk adjustment and reinsurance can help protect health plans covering treatment for mentally ill individuals against risk selection. This model analysis may be useful for advocates for individuals with mental illness in considering their own state's insurance exchange. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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